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1

Patients receiving parenteral nutrition through central venous catheter are at a high risk for

Candidemia (pseudohyphae with blastoconidia)

2

Low testosterone with decreased FSH and LH

Hypogonadotropic hypogonadism (Kallman Syndrome) just one example

3

LOS is like LPS but lacks

repeating O antigent (amount of LOS correlates to NM disease severity)

4

LOS of N. meningitidis causes sepsis via what cytokines?

TNF-alpha, IL-1b, IL-6, IL-8 due to interaction with toll like receptor 4

5

Causes of Asherman syndrome

Postpartum endometritis and dilation/curettage

6

MDD: SIG E CAPS (5+ present for longer than 2 weeks)
Dont forget:
Depressed mood

S- Sleep disorder
I-Interest deficit (anhedonia)
G- Guilt (worthlessness, hopelessness, regret)
E- Energy deficit
C-concentration
A- Appetite disorder
P- psychomotor retardation or agitation
S- Suicidality

7

Adenomyosis is common in what age group

middle aged parous females

8

Heavy menstrual bleeding, dysmenorrhea, and on exam a UNIFORMLY enlarged uterus (from hormonal stimulation of endometrial glandular tissue in myometrium)

Adenomyosis

9

Fibroids

Leiomyomas caused by proliferation of myometrial smooth muscle cells. IRREGULARLY enlarged uterus and heavy menstrual bleeding

10

Hyperplastic growth of endometrial glands and stroma leading to a benign projections of uterine lining. Do not cause uterine enlargement

Endometrial polyps

11

During first few weeks of embryogenesis Hb is synthesized by _______

Yolk sac (zeta or epsilon)

12

Hb F begins around 8 weeks gestation and replaces embryonic Hb by 14 weeks. Where is it made?

Spleen and liver (by 14 weeks erythropoiesis is taking place here

13

Hb H (3 deletions of alpha gene) manifest as

chronic hemolytic anemia (note: Hb Barts- gamma4 is not compatible with life- hydrops fetalis

14

Sources of ALK phos other that osteoblast

Placenta during pregnancy, liver, and intestine

15

Difference btw liver and bone alk phos

Bone= boil (easily denatured). Electrophoresis can be used and so can monoclonal antibodies

16

Osteoclast produce: It is tartrate-resistant and is unstable in frozen serum samples

Acid phosphatase

17

Measurement of osteoClastic activity?

1) Urine deoxypryridinoline (pryridinoline covalently cross links collagen fibers)
2)Tartrate resistance

3) hydroxyproline could be used but can be fasely high in urine due to meat products (shitty)

18

Ipratropium

Anti-muscarinic (bronchodilation) + blocks the parasympathetic stimulation of tracheobronchial submucosal glands in the lungs (great add benefit for asthma and COPD)

19

Inhaled glucocorticoid used for the prophylactic treatment of bronchial asthma

Flunisolide

20

How does Nifedipine cause bronchodilation

By blocking calcium influx into bronchial smooth muscle

21

Bronchodilation by blocking PDE activity--> increasing intracellular cAMP

Methylxanthines (theophylline and aminophylline)

22

Inhibitor of lipoxygenase pathway for prophylactic asthma therapy

Zileuton

23

benign nerve sheath neoplasms predominantly comprised of SCHWANN CELLS (derived from neural crest cells)

Cutaneous Neurofibromas

24

spontaneous episodes of rest and nighttime angina with transient ST elevation

Vasospastic or variant (prinzmetal) angina

25

Drug causes of vasospactic angina?

Dihydroergotamine, cig smoking, cocaine/amphetamines, triptans

26

What can be used to treat vasospastic angina?

Nitroglycerine to treat acute. Prophylactic Ca++ channel blockers (don't forget smoking cessation)

27

Acts as vasodilator reducing SVR and increases venous capacitance. Also sympatholytic effects on cardiovascular system. Can be used for severe pain in acute MI

Morphine

28

Decrease left ventricular volume and stress via VENO>arterial dilation

Nitrates

29

Vitamin D toxicity

Hypercalcemia--> impaired depolarizatins of neuromuscular membranes (muscle weakness, constipation and mental status change) and impaired concentration of urine at distal tubule (polyuria, polydipsia). Dehydration
Note: hypercalciuria also seen

30

PTH-independent conversion of 25-hydroxyvitamin D to 1,25 dihydroxyvitamin D (calcitriol) by 1-alpha-hydroxylase (expressed in activated macrophages)

Seen in granulomatous diseases (sarcoidosis, tuberculosis)
-Increased intestinal absorption of calcium

Can also be seen in Hodgkin Disease and some non-Hodgkin lymphomas

31

Biliary obstruction alters lipid absorption and can lead to

FAT soluble vitamin deficiencies

32

Carcinoid Syndrome can have pallegra (niacin def.)

Tryptophan---> Serotonin (all shunts this way). Niacin hardly produced

33

Impaired incorportation of copper into ceruoplasmin and defective excretion of excess copper into bile (elevated free copper and deposition in the liver and other organs)

Wilsons Disease: ATPB7 gene Chromosome 13
Autosomal Recessive

TX: chelation w/ penicillamine or trientine, oral zinc

34

Mental status changes, muscle weakness, constipation, polyuria/polydipsia, and dehydration

Hypercalcemia presentation

35

Superficial branching nests of distended capillaries

telangiectasias

36

Ataxia-telangiectasia predisposes to...
Note: deficiency in both cell-mediated and humor dysfunction

Increased risk of hematologic malignancies

37

Hypersensitivity to X-ray radiation that causes multiple chromosomal breaks. ATM gene mutated responsible for DNA break repair. AR

Ataxia- Telangiectasia

38

Choreoathetoid movement and spasticity also seen in Lesch-Nyhan. Inheritance?
HGPRT nemonic

X-Recessive

39

Immunodeficiency resulting from a defect in expression of HLA-II antigens on surfaces of APCs. Note: MHC class II present foreign antigen to T cells to elicit a cell mediated AND humoral response (because T cells must first activate B cells to mature and undergo class switching)

Bare Lymphocyte syndrome

40

HSM, anemia, motor neuropathy-->hypotonia and areflexia, and cherry red spot on mucula

Niemann-Pick disease (AR)
Defect in sphingomyelinase--> shingomyelin accumulates within monocytic cells (early death in child hood)

41

Wide, fixed splitting of S2 that does not vary with respiration

ASD

42

ASD-->L-R shunt-->P.HTN via laminated medial hypertrophy-->Pulm vascular resistance > total SVR--> Eisenmenger syndrome ensues (due to pulmonary HTN). What will the pulmonary valve show over time?

Closure of ASD may be required to prevent IRREVERSIBLE pulmonary sclerosis and a permanent Eisenmenger syndrome

43

Pulmonary edema due to HTN emergency. Give Nitroglycerine, Nitroprusside. Used to improve acute heart failure by reducing

Afterload

44

Nitrates (NO) --> activate sGC--> Increased cGMP in endothelium decreases INTRACELLULAR CALCIUM--> decrease myosin light-chain kinase--> leading to myosin light chain dephosphorylation and _______

vascular smooth muscle relaxation

45

Check for association btw 2 CATEGORICAL (%) variables

Chi-square
Ex: determine if the distribution of gender and smoking status is random or if there is a difference between the sexes regarding smoking status.

46

Used to compare the difference between the means of 2 groups

t-test

47

Compares the difference between the means of 2 or more groups

ANOVA

48

Studies assessing the effects of aspirin on certain cardiovascular events may be inconclusive. However, analysis of data compiled from multiple clinical trials may reveal significant benefit.

Meta-analysis
"pooling data from several studies to perform an analysis having greater statistical power than individual studies themselves"

49

Model the linear relationship btw dependent variable and 2 or more independent variables.

Multiple linear regression
Ex: quantify the effects of alcohol use, tobacco smoking and charred food consumption on the incidence of gastric cancer.

50

measure of the strength and direction of a linear relationship btw 2 variables

Pearson correlation coefficient
Ex: Average blood glucose levels and HbA1c

51

Treatment for pufferfish tetrodotoxin (voltage Na sodium block)

Gut lavage and charcoal

52

Originate above the dentate line and are covered by columnar epithelium. Autonomic innervation from the inferior hyogastric plexus (sensitive to stretch not pain, temp, or touch)

Internal Hemorrhoids

53

External hemorrhoids (painful if thrombose) originate below the dentate line and are covered by _________ epithelium and have cutaneous (somatic) innervation from ________

1) modified squamous
2) Inferior rectal nerve (branch of pudendal nerve)

54

Supply the perineum and external genitalia in males and females are very sensitive to touch, temp, and pain

Branches of pudendal nerve

55

Derived from L1, carries sensation from:
-skin of the upper and medial part of the thigh
-root of the penis and upper part of the scrotum
-mons pubis and labia majora (females)

Ilioinguinal nerve

56

Inferior gluteal nerve? Branches? Innervation?

L5,S1-S2
Motor to gluteus maximus

57

sympathetic and parasympathetic components (innervates the internal pelvic viscera but not the external perirectal area

inferior hypogastric plexus

58

derived from S2,S3, and S4 and provide parasympathetic innervation to the pelvic and genital organs

pelvic splanchnic nerves

59

Continuation of hypogastric nerve with additional input from the pelvic and sacral splanchnic nerves. Gives rise to prostatic plexus (w/in fascia of prostate)

Inferior hypogastric plexus

60

________ and _______ ________ _______ arise from the prostatic plexus and pass beneath the pubic arch to innervate the corpa cavernosa of the penis and urethra

Greater and lesser cavernous nerves: carry post ganglionic parasympathetic fibers---> facilitate erection

61

Prostatectomy or injury to prostatic plexus can cause

ERECTILE dysfunction--> thus surgeons try to preserve integrity of prostatic fascial shell during surgery.

62

Detrusor muscles are controlled by what nerves? Overactivity can lead to what?

1) Parasympathetic fibers from pelvic splanchnic nerves and inferior hypogastric plexus.
2) Urge incontinence (women>men)

63

Innervation of external urethral and anal sphincters. Sensory to external genitalia.

Branches of pudendal nerve

64

Fecal incontinence, decreased penile sensation, or external urethral sphincter paralysis due to injury to what nerve?

Pudendal nerve

65

Cremasteric reflex

Genitofemoral nerve (L1-L2 spinal nerves origin)
Loss of reflex is seen is testicular torsion or L1-L2 spinal injury

66

Tracheobronchitis

Mycoplasma pneumonia

67

Can lead to complement mediated, intravascular hemolytic anemia due to similarity between antigens in the cell membrane of ________ and the cell membrane of erythrocytes (I-antigen)

M. pneumoniae

68

Extrapulmonary manifestations of M.pneumoniae

SJS, joint pains, encephalitis, cardiac rhythm, bullos myringitis

69

Lack of cell wall facilitates resistance (stripped down genome that can not perfom metabolic function (peptidoglycan cell wall and synthesis of purines)

M. pneumoniae (no bacterial cell wall antigen; phospholipid bilayer cell membrane only)

70

Enzyme deficiencies that cause anemia

G6PD and pyruvate kinase

71

-AR
-RBCs most effected (no mito thus anaerobic respiration)
-Loss of ATP
-Membrane failure--> phagocytosis in spleen (extravascular hemolysis)
-New born with anemia and spleenomegaly (severe)

Pryuvite Kinase deficiency

72

Increases amino acid transport and ribosomal translation efficiency in muscle, adipose and liver tissue

Insulin

73

Lack of insulin induces catabolic state, and patients typically lose weight despite normal or increased appetite

New-onset DM1

74

Stimulates glucagon release
Increases release of glucose from the liver
Decreases peripheral uptake of glucose

Epinephrine

75

increases renal absorption of sodium, leading to increased blood volume and blood pressure

Insulin (glucose reuptake is INDEPENDENT OF INSULIN)

76

Most common congenital breast anomalies in women and men are

accessory nipples (polythelia, supernumerary nipple)

77

Cause of polythelia/supernumerary nipple (asymptomatic but may swell or become tender during menses, pregnancy, and lactation)

failure of involution of mammary ride

78

Hyperpigmentation, epidermal thickening, pilosebaceous structure of Montgomery areolar tubercles, smooth muscle bundles (areola) and possible mammy glands and multiple ducts

Accessory nipple histo (similar to normal nipple)

79

Clonal proliferation of benign melanocytes in utero. Can be raised are hyperpigmented

Congenital melanocytic nevi

80

Increased melanin production on sun-exposed areas

Ephelides (freckles)

81

Increased proliferation of melanocytes! Larger than freckles also flat) and are seen in adults

solar lentigines

82

Skin tags, benign, pedunculated outgrowths of normal skin. In locations of friction (below breast or axillae)

Acrochorda

83

Sudden onset of heart failure in 10% of people with severe aortic stenosis

Atrial fibrillation
(decrease preload to LV (hypotension) and pulmonary edema (increase pulm. venous pressure)

84

Scurvy in children is more severe than the normal easy bruising, periodontal disease, poor wound healing, and hyperkeratotic follicles

Children= hemorrhages, bony deformities, and subperiosteal and joint hematomas

85

Hydroxyproline and hydroxylysine are essential for cross-linking collagen molecules. Failure to hydroxylation is due to

prolyl and lysyl hydroxylases not having vitamin C to function as reducing agent. Results in decreased tensile strength of collagen

86

Hesselbach's triangle (direct hernia goes through). Boarders?

Inferior: Inguinal ligament
Lateral: Inferior epigastric
Medial: Rectus abdominus muscle
Floor: Trasnversalis fascia (weakness can lead to protrusion of abdominal contents through triangle into inguinal canal)

87

Direct vs. indirect coverings

Indirect (thru deep inguinal ring): all three spermatic fascial layers)
Direct (superficial ring): external spermatic fascia only

88

Due to failure of processus vaginalis to obliterate and the internal inguinal ring to close.

Indirect inguinal hernias (most common type of hernia)
Protrude lateral to inferior epigastric artery

89

If pertechnetate or perchlorate are present, uptake of iodine isotypes will decrease due to competitive inhibiton

NIS (sodium-iodide symporter) located on basolateral membrane transports perchlorate, pertechnetate, and iodide into thyroid follicular cell

90

______ treatment can cause a transient worsening of hyperthyroidism (elerdly or severe disease) are started initially on anti-thionamides (propylthiouracil, methimazole)

Radioiodine

91

Hyperthyroidism-->Increased sympathetic activity

Beta-blockers can provide initially sympathetic relief and are often continued during radioactive iodine tx

92

Contains factors VIII, XIII, vWF, and fibrinogen (precipitate obtained from FFP by centrifugation/thawing)

Cryoprecipitate

93

Brodifacoum, a long-acting 4-hydroxycoumarin derivative

Rodenticides. Tx: FFP in addition to vitamin K (IM)

94

Distal tubule sodium sensor

macula densa

95

Beta-adrenergic antagonist inhibit _____ release via B1 receptors on Juxtaglomerular cells

Renin

96

Inhibits sacral micturition center

Cerebral cortex

97

Located in the pontine reticular formation. Coordinates relaxation of external urethral sphincter with bladder contraction during voiding

Pontine micturition center

98

Located at S2-S4 level and responsible for bladder contraction. Parasympathetic fibers travel from S2-S4 ventral white matter within pelvic nerves and stimulate cholinergic receptors in the bladder wall

Sacral micturition center

99

Normal pressure hydrocephalus-->decreased CSF absorption-->ventricular enlargment--> traction on cortical efferent and afferent fibers (corona radiata). Traction disrupts periventricular pathways that transmit impulses from the cortex to the sacral micturition center. Later in disease, lack of cerebral cortex inhibition to sacral micturition center leads to

Urge incontinence (uncontrolled and frequent micturition)
Bladder fills with urine and empties reflexively when full. Patient has no control over bladder function or sensation. Voluntary relaxation of urethral sphincter remains intact

100

APML (M3 variant)

Risk for DIC

t(15;17)
PML gene on 15 and RARA on 17
Codes for abnormal retinoic acid receptor, which then inhibits myeloblast differentiation.

101

Smear of APML

Abnormal promyelocytes and aeur rodes

102

Anemia (fatigue, pallor), thrombocytopenia (petechiae, hemmorrhages) and neutropenia (fever, opportunistic infections, result from marrow replacement by leukemic cells

AML manifestations clincally

103

Defective PDGF receptor plays a role in pathogenesis of several cancers. Name one?

Ovarian

104

Two most common causes of SVC syndrome

Lung cancer> non-Hodgkin lymphoma

105

Dyspnea, distended neck veins, distal heart sounds and pulsus paradoxus (decrease in systolic pressure >10mmHg during inspiration)

Pericardial effusion

106

Arise at lung apex. Shoulder pain (brachial plexus). Horners syndrome (cervical sympathetic plexus).

VERY VERY rarely SVC syndrome

Superior sulcus tumors (Pancoast tumors)

107

most selective determinant of particle size penetrance (renal)

GBM and slit diaphragms (btw foot processes of epithelial cells)

108

Charge selectivity is provided by (renal)

Negatively charged anions (heparan sulfate and other proteoglycans).
Located on endothelial cells in GBM

*Reason for albumin leak in MCD (loss of molecules)

109

Tubular proteinuria: presence of low molecular weight proteins ( such as.....) that are normally filtered and reabsorbed in PCT. Appear in urine with PCT function in disrupted as in tubulointerstitial nephritis (P's)

B2-microglobulin, immunoglobulin light chains (multiple myeloma), AAs, and retinol-binding protein

110

Functional proteinuria

Caused by change in blood flow through glomerulus
Excercise, high fever, stress, or cold exposure
Common in young adults with normal renal function. Disappears on repeated testing

111

Orthostatic Proteinuria

Older, tall, thin adolescents
increased protein excretion in upright position, but normal when supine/sleeping
Normal renal function (albuminuria less than 1g a day and normal at night )

112

Highly selective proteinuria: mostly low-molecular weight proteins such as albumin and transferrin excreted

MCD

113

Bloody diarrhea with or without abdominal pain is the hallmark of

Ulcerative colitis (in Crohn's disease there may also be bloody diarrhea but abdominal pain is virtually always present

114

Complications of UC

Toxic megacolon (most dangerous) can lead to perforation. UC increases risk for adenocarcinoma of colon.